title: Mycobacterium chelonae infection among patients receiving high-flux dialysis in a hemodialysis clinic in California.
abstract: Between July 1987 and January 1988, five patients dialyzed at a hemodialysis outpatient clinic developed systemic Mycobacterium chelonae abscessus (MCA) infections. Four of the five patients had arteriovenous graft infections, and two died during antimicrobial therapy. Case-patients were more likely than control-patients to have received high-flux dialysis during the 6 mo before their infection (100% vs. 30%, P = .009). MCA was cultured from the hose connected to a water spray device used for manual reprocessing of high-flux but not regular dialyzers. Renalin was the germicide used to manually disinfect dialyzers for reuse and was prepared at a concentration of 2.5%. Laboratory studies documented survival of MCA from two high-flux dialyzers that were reprocessed in a manner similar to that used in the clinic. Early diagnosis with complete rather than partial graft removal in combination with antimicrobial therapy is recommended for MCA graft infections. In addition, 2.5% Renalin did not appear to ensure complete killing of MCA in high-flux dialyzers that were manually reprocessed at this hemodialysis clinic.
authors.affiliation: Hospital Infections Program, Centers for Disease Control, Atlanta, Georgia 30333.
authors.forename: P W
authors.initials: PW
authors.lastname: Lowry
authors.forename: C M
authors.initials: CM
authors.lastname: Beck-Sague
authors.forename: L A
authors.initials: LA
authors.lastname: Bland
authors.forename: S M
authors.initials: SM
authors.lastname: Aguero
authors.forename: M J
authors.initials: MJ
authors.lastname: Arduino
authors.forename: A N
authors.initials: AN
authors.lastname: Minuth
authors.forename: R A
authors.initials: RA
authors.lastname: Murray
authors.forename: J M
authors.initials: JM
authors.lastname: Swenson
authors.forename: W R
authors.initials: WR
authors.lastname: Jarvis
mesh_terms: D019342:Acetic Acid; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002140:California; D016022:Case-Control Studies; D015331:Cohort Studies; D004202:Disinfectants; D004338:Drug Combinations; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D006861:Hydrogen Peroxide; D008297:Male; D009161:Mycobacterium / Q000302:isolation & purification; D009164:Mycobacterium Infections / Q000453:epidemiology / Q000209:etiology*; D010463:Peracetic Acid; D011897:Random Allocation; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D014871:Water Microbiology; D014881:Water Supply
chemical_list: D004202:Disinfectants; D004338:Drug Combinations; C117603:Renalin; D006861:Hydrogen Peroxide; D010463:Peracetic Acid; D019342:Acetic Acid